Diagnosis of Anemias Flashcards
(43 cards)
1
Q
Normal RBC
(diameter, volume, shape)
A
- *Diameter:** 6 - 8 µ
- *Volume:** 90 fL
- *Shape:**
- Biconcave disk
- Area of central pallor: 1/3 of cell
2
Q
Identify
A
Normal red blood cells. Note small mature lymphocyte nucleus as “ruler” for RBC size
3
Q
RBC Assessment
(6 steps)
A
- Appropriate Size
- Appropriate Color
- Appropriate Shape
- Appropriate Inclusions
- Appropriate Distribution
- Is the abnormality uniformly distributed?
- Is the abnormality likely to be artifact?
4
Q
RBC Size categories
(3, causes, term for when they coexist)
A
Sizes
- Normocytic
- Macrocytic
- Impaired DNA synthesis (B12/folate deficiency)
- Accelerated erythropoiesis (hemolysis)
- Increased cholesterol and lecithin (liver disease)
- Microcytic
- Ineffective Fe utilization
- Decreased or defective globin synthesis
**Mixed (pathologic) **Ansiocytosis
5
Q
Identify
A
Ansiocytosis
- Identifying factors:*
- Increased red cell distribution width (RDW)
6
Q
Identify
A
Macrocytosis
- Identifying factors*
- RBC diameter > small mature lymphocyte diameter
7
Q
Identify
A
Microcytosis
- Identifying factor*
- RBC diameter < small mature lymphocyte nucleus diameter
8
Q
RBC Colors
(3, causes, pathology when mixed)
A
Colors
- Normochromic
- Hypochromic
- Fe deficiency, thalassemia, Pb poisoning
- Hyperchromic
- Spherocytes
Patholgy of mixed shades
Polychromasia
9
Q
Identify
A
Hyperchromic RBCs
Identifying Factors:
- Dark comparative color
- Loss of central pallor
10
Q
Identify
A
Hypochromic RBC
Identifying Factors
- light colored cells, especially compared to lymphocyte
- central pallor > 1/3 cell
11
Q
Describe the RBCs
A
Hypochromic (MCHC)
Microcytic (MCV)
12
Q
Identify and explain significance
A
Polychromasia
Identifying Factors
- multiple shades of WBC
- variable central pallor size
Explaination
- Polychromasia implying presence of reticulocytes (need special stain for discrete ID) should exist in 1% of the cell population
- Excess polychromasia likely indicates there is an increase in ciruculating immature RBC, a sign of functioning bone marrow with dysfunctioning RBC or RBC monitoring mechanism. Usually a hemolytic anemia
13
Q
Identify
A
Reticulocytes
Identifying Factors
- Presence of supernormal stain - only place retics can be positively identified (although they can be implied with polychromasia in a typical stain)
- Granulations (RNA) within RBCs
14
Q
Cell shapes
(10 shapes, condition of multiple shapes)
A
Shapes
- Target cells
- Spherocytes
- Elliptocytes
- Ovalocytes
- Stomatocytes
- Sickle cells
- Acanthocytes
- Echinocytes/Burr cells
- Schistocytes (fragmented cell)
- Teardrop cells
Condition - Poikilocytosis
15
Q
Identify
(plus 4 common causative conditions)
A
Target Cells
- Identifying Factors*
- Central pallor c darkened center
- Associated Conditions (always a board question)*
- Hemoglobinopathies
- Thallasemia
- Liver disease
- Fe Deficiency
16
Q
Identify
(plus three associated conditions)
A
Spherocytes
Identifying Factors
- Mycrocytic
- Hyperchromic
Associated Conditions
- Immune hemolytic anemias (sections holding antigens removed from RBC membrane when passing thru spleen, make RBC smaller but does not signficantly decrease hemoglobin concentration)
- Post-transfusion (inability to regulate osmotic pressure)
- Hereditary
Note
- Fragile cells
- Tested for with direct (or indirect) Coomb’s test
17
Q
Describe the probable cell shape
A
Spherocytosis
18
Q
Identify
(plus three common causative conditions)
A
Elliptocytes
- Identifying Factors*
- 2 sides of RBC are parallel
- Causative Conditions*
- Hereditary (most cells will be elliptocytes)
- Fe Deficiency (not predominating, “squeezed” cells)
- Myelofibrosis (not predominating, “squeezed” cells)
19
Q
Identify
(plus 2 common causative conditions)
A
Ovalocytes
- Identifying Factors*
- Oval shape
- Causative Conditions*
- Myelodysplastic syndrome
- Megaloblastic anemia
20
Q
Identify
(plus three common causative conditions)
A
Stomatocytes
Identifying Factors
- “stoma” or “mouth-like” slits in RBC
- cells that appear folded over on themselves
Causative Conditions
- Artifact (won’t be reported)
- Acute alcoholism
- Malignancies
21
Q
Identify
(plus one common causative agent)
A
Sickle Cells
- Identifying Factor*
- Long, pointed, sickle-like cells
- Common Causative Agent*
- Sickle Cell Disease
- Note*
- Shape change due to rigid tactoids of hemoglobin S in the presence of hypoxia
22
Q
Identify
(plus three common causative agents)
A
Acanthocytes
- Identifying Factors:*
- Irregular spicuoles
- Causative Conditions (liver or lipid)*
- Inherited lipid disorders
- Alocholic cirrhosis
- Neonatal hepatitis
23
Q
Identify
(plus 4 common causative conditions)
A
Burr Cells (Echinocytes)
- Identifying Factors*
- star-like projections out of round RBC
- Causative Conditions*
- Artifact (poor drying conditions, prolonged storage)
- Renal insufficiency
- Severe dehydration
- Burns
Note - will only be reported if significant, not artifact)
24
Q
Identify
(Plus four common causative agents)
A
Schistocytes (cell fragments)
- Identifying*
- irregular, variable sized cell fragments mixed c regular RBCs
- Common Causative Conditions - Micropathic hemolytic anemias*
- Disseminated Intravascular Coagulation
- Thrombotic Thrombocytopenic Purpura (TTP)
- Hemolytic Uremic Syndrome (HUS)
- Traumatic hemolytic anemia
Notes
- Blocked vessel or interfered flow in vessel
- TTP and HUS have fibrin strands projecting into vessel that disturb RBC (chain linked fence)
- Traumatic hemolytic anemia and microangiopathic hemolytic anemia can be due to prosthetic heart valve
25
Identify
| (plus four common causative conditions)
**Teardrop Cells**
* Identifying Factors*
* *One pointed projection, tear drop looking*
* Common Causative Conditions*
* *Extramedullary hematopoiesis*
* *Megaloblastic anemia*
* *Thallasemia*
* *Hypersplenism*
*Note - these cells are usually produced by secondary hematopoietic locations, usually spleen or liver. They have to squish through the capillaries so they are shaped differently*
26
RBC Inclusions revealed on Wright Stain
| (8)
1. Howell-Jolly bodies
2. Basophilic stippling
3. Siderotic granules
4. Pappenheimer bodies
5. Nucleated RBC
6. Cabot rings
7. Hemoglobin C crystals
8. Parasites (malaria, etc.)
27
Identify
**Howell Jolly Bodies**
* Identifying Factors*
* *small dark dots inside the RBC*
* Note - nuclear fragmetns due to karyorrexis*
28
Identify
**Basophilic Stippling**
* Identifying Factors*
* *Bluish/gray spots or granulations inside RBC*
* Common Causative Conditions*
* *Thalassemia*
* Defective heme synthesis
* Pb poisining (coarse)
29
Identify
**Pappenheimer Bodies**
* Identifying Factors*
* *clusters of small round inclusions - _grape clusters_*
* Common Causative Conditions*
* *Sideroblastic anemia - extra iron*
* *Hemoglobinopathies - excess iron in peripheral blood post transfusion*
* *Thalassemia*
* *Post-splenectomy*
* *Hemochromatosis - hereditary disorder of iron disposition*
30
Identify
| (plus two common causative conditions)
**Nucleated RBC**
* Identifying Factors*
* *looks like lymphocyte, but there is significant cytoplasm to one side of cell*
* Causative*
* *Normal finding in infants*
* *Erythroid hyperplasia in adults*
* Note*
* *Will increase polychromasia/retic count*
31
Identify
| (one common causative condition)
**Hemoglobin C Crystals**
*Identifying Factors*
* *dark, rectangular central pallor*
* *shown here in rectangular cells, but could also exist in rounded cells. The rest of the cell will show pallor*
* Common Causative Condition*
* *Hemoglobin C disease post splenectomy (spleen will destroy them normally)*
32
Identify
| (one common causative agent)
**Parasitemia**
* Identifying factors*
* small dark granuoles inside RBC
* Common Causative Condition*
* *malaria*
* Note - try not to get confused if there is a platelet on top of the RBC (pictured)*
33
Methods of Peripheral Blood Smear Examination
(three microscope settings)
1. Low Power Scan (x10X)
2. High Power Exam (x40X)
3. Oil Immersion Examination (x100X)
34
Low Power Scan Uses
| (3)
1. Evaluate Stain quality
2. Distribution
* Agglutination
* Rouleaux
3. Optimal area for differential and morphology
35
Identify
**RBC Agglutination**
## Footnote
*RBC has cold agglutinin*
36
Identify
| (one causative agent, pathophys)
**Rouleaux Formation**
* Pathophysiology*
* *excess protein on RBC membrane causes chain-like sticking*
* Common Causative Condition*
* *multiple myeloma*
37
Oil Immersion Examination
| (3 Uses)
1. 100 WBC differential count
* WBC morphology
* Nucleated RBC correction
2. RBC Morphology
3. Platelet Estimate
38
Anemia Classification Schemes
(2, describe groups - each classification has three)
1. **Functional Classification**
1. Maturation
* Cytoplasmic
* Nuclear
2. Hypoproliferative
* Decreased EPO
* Iron Depletion
* Marrow damage
3. Hemolysis or hemorrhage
2. **Morphologic classification**
1. Microcytic
2. Normocytic
3. Macrocytic
39
Microcytic Anemia
(Two physiologic causes, 2 and 4 associated conditions)
* Decrerased serum Fe
* Iron deficiency
* Anemia of chronic disease (cant get iron out of macrophages)
* Normal or increased serum Fe
* Thalassemia syndromes
* Sideroblastic anemia
* Lead poisoning
* Porphyrias
40
Normocytic Anemia
(two physiologic causes, 2 and 3 specifics)
Inceased reticulocyte production
* Acute blood loss
* Hemolytic anemia
* Immune
* Non- immune (intrinsic vs extrinsic)
Normal or decreased reticulocyte production
* Bone marrow failure (aplastic anemia)
* Infection
* Malignancy
41
Macrocytic Anemia
(2 physiologic categories, 1 and 4 specifics)
With increased reticulocyte production
* Hemolytic anemias with marked reticulocytosis
With normal or decreased reticulocyte production
* Megaloblastic anemia
* Myelodysplastic syndromes
* Liver disease
* Medication or chemotherapy
42
Peripheral Blood Smear
| (3 uses)
1. Coexisting leukopenia or thrombocytopenia
2. Size and shape of RBC
3. RBC inclusions
43
Bone Marrow Examination
| (5 uses)
1. Maturation of RBC and WBC
2. Presence of megakaryocytes
3. M:E Ratio
4. Iron stores
5. Presence of abnormal elements
